Prehospital Academy Lesson 22.3
HEENT: Common Nose and Throat Diseases
This lesson covers common diseases of the nose and throat that EMTs may encounter. While many of these conditions are not life-threatening, they can cause significant discomfort and, in some cases, lead to severe complications, including airway compromise.
Diseases of the Nose
1. Rhinitis:
Inflammation of the nasal cavity.
Causes: Allergens (allergic rhinitis/hay fever), medications, environmental temperature changes, bacterial/viral infections.
Symptoms: Nasal congestion, sneezing, itchy/runny nose, itchy eyes, postnasal drip.
Management: Prehospital care is supportive. Transport may be needed for evaluation at a definitive care facility.
2. Sinusitis:
Inflammation of the paranasal sinuses. It can be chronic, acute, or recurrent.
Causes: Viral or bacterial infections, allergies, anatomical blockages.
Symptoms: Sinus pressure/pain, headache (often worse when leaning forward), purulent nasal discharge, fever, facial tenderness.
Complications: Sinus headaches, migraines. Rarely, infection can spread to surrounding tissues (e.g., orbital cellulitis).
Management: Monitor for respiratory compromise. Treatment is aimed at reducing inflammation and promoting sinus drainage. Prehospital care is largely supportive.
Diseases of the Throat and Oral Cavity
1. Dentalgia and Dental Abscess:
Dentalgia: A common toothache.
Dental Abscess: A collection of pus within the gums or teeth, resulting from a bacterial infection.
Complications: Infection can spread to facial tissue, bone, and the neck. If it becomes systemic, it can lead to septicemia. An abscess in the throat or neck can compromise the airway.
Management: Prehospital treatment is aimed at symptom relief. If airway compromise is present or developing, it becomes a true emergency requiring aggressive airway management.
2. Oral Candidiasis (Thrush):
An accumulation of the fungus Candida albicans on the lining of the mouth, presenting as creamy white lesions on the tongue, inner cheeks, and sometimes the roof of the mouth, gums, or tonsils.
Common in: Babies, patients with compromised immune systems, those who wear dentures, or patients using inhaled corticosteroids.
Management: Prehospital management is supportive. Significant pain can occur if tissues crack or bleed. It's crucial to assess for underlying life-threatening conditions (e.g., immunosuppression due to HIV/AIDS) that thrush can be a sign of.
3. Ludwig's Angina:
A type of rapidly progressing cellulitis on the floor of the mouth, often caused by bacteria from an infected tooth root or mouth injury.
Presentation: Redness and swelling of the neck and under the chin, difficulty breathing or swallowing, drooling, altered speech, neck pain, fever.
Management: THIS IS A PREHOSPITAL EMERGENCY.
Airway Management: The primary concern. Edema can rapidly compromise the airway. Be prepared for aggressive airway management, including early consideration of an advanced airway by ALS providers.
Positioning: Allow the patient to assume a position of comfort that protects their airway.
Transport: Rapid transport to an appropriate facility.
4. Peritonsillar Abscess:
A collection of pus that forms in the tissue around the tonsils, often a complication of tonsillitis.
Presentation: Severe sore throat (usually unilateral), muffled voice ("hot potato voice"), fever, trismus (difficulty opening the jaw), drooling, deviated uvula.
Management: A significant concern for airway compromise due to swelling. Do not unnecessarily irritate the tissue. Be prepared for airway management if the patient's condition deteriorates. Transport for definitive care (incision and drainage, antibiotics).
5. Temporomandibular Joint (TMJ) Disorders:
Disorders affecting the temporomandibular joint, which connects the jawbone to the skull.
Causes: Arthritic damage, jaw injury, or muscle fatigue from grinding/clenching teeth.
Presentation: Jaw pain, headache, difficulty chewing, locking of the jaw joint.
Management: Prehospital care is supportive and focused on pain relief and comfort.
Critical Thinking Questions
You respond to a patient with a severe sore throat, muffled voice, and difficulty opening their mouth. You observe that their uvula is deviated to the left. What condition do you suspect, and what is your primary concern?
A patient presents with swelling under their chin, difficulty swallowing, and drooling after a recent tooth extraction. Why is this considered a prehospital emergency, and what specific interventions must you be prepared for?
You are assessing an immunocompromised patient and notice white, creamy patches on their tongue and inner cheeks. What is this condition called, and what does its presence suggest about the patient's overall health?
How would you differentiate the pain of a sinus headache from a tension headache based on a patient's history and your physical assessment?
During an assessment of a patient with oral pain, you note that an untreated dental abscess is a potential risk for what life-threatening systemic infection?